Hip examination

Follow the scheme below:

• Inspection
• Palpation
• Measurment
• Movement

Before starting

• Introduce yourself
• Explain what the examination entails
• Ask permission to perform examination
• Expose the patient appropriately - from waist down exposing both the lower limbs, but leaving the underwear on
• Preserve dignity by using a blanket appropriately
• Tell the patient to let you know if anything you do is uncomfortable
• Remember - always watch the patients face 

Inspection

• General observation
  • Does the patient look well?
  • Is there a walking stick? Frame?
  • Is there a shoe raise?
  • Hands (Rheuamtoid arthritis?) 

Patient Standing

• Remember to inspect from all sides (front, laterally and from behind):
  • Skin
    • Scars (previous injuries or surgical scars)
    • Sinuses (secondary to TB or infected hip replacements)
    • Colour - discolouration?
  • Deformity
    • Abduction / adduction contracture
    • Fixed flexion deformity
    • Limb shortening
    • Limb rotation
    • Scoliosis
    • Lumbar lordosis 
  • Swelling (the hip joint is deep and thus swelling is not generally seen)
  • Muscle wasting - look at the gluteal folds
    • gluteals? quadraceps?
  • Pelvic obliquity (anterior superior iliac spines (ASIS) not horizantal)
    • Is there a leg length discrepancy?
    • Is there a fixed deformity?

Patient Walking

• Observe the patient walking.
  • Gait pattern. There are different types of gait:
    • Stiff hip (pelvis swing)
    • Antalgic (short stance phase)
    • Short leg
    • Trendelenburg (Lurching gait, watch the shoulders)
    • Drop foot gait 
    • Broad based gait (ataxia)
  • Stride length
  • Use of a walking aid

Patient Lying down - supine with one pillow under the head

• Observe the patient climb onto the examination couch
• Deformity
  • Rotational deformity is common in osteoarthritis (observe the position of the patella and foot on either side)
  • Fixed flexion deformity (look at the angle between the thigh and the bed). Perform Thomas's test at this stage (see below) 
  • Abduction / Adduction deformity (adduction deformity - tilted pelvis and apparent shortening of that leg)
• Detailed check:
  • Skin - scars

Palpation